Low dosage serotonin 5-ht2a receptor agonist to suppress inflammation

ABSTRACT

Activation of 5-HT2A receptors using agonists at surprisingly low concentrations was shown to potently inhibit TNF-α-induced inflammation in multiple cell types. Significantly, proinflammatory markers were also inhibited by the agonist, (R)-DOI, even many hours after treatment with TNF-α. With the exception of a few natural toxins, no current drugs or small molecule therapeutics demonstrate a comparable potency for any physiological effect. TNF-α and TNF-α receptor mediated inflammatory pathways have been strongly implicated in a number of diseases, including atherosclerosis, asthma, rheumatoid arthritis, psoriasis, type II diabetes, depression, schizophrenia, and Alzheimer&#39;s disease. Importantly, because (R)-DOI can significantly inhibit the effects of TNF-α many hours after the administration of TNF-α, potential therapies could be aimed not only at preventing inflammation, but also treating inflammatory injury that has already occurred or is ongoing.

The benefit of the 10 Jul. 2008 filing date of U.S. provisional patentapplication 61/079,576 is claimed under 35 U.S.C. § 119(e).

This invention was made with United States government support underGrant Nos. P20RR018766 and HL072889 awarded by the National Institutesof Health. The United States government has certain rights in thisinvention.

The instant application contains a Sequence Listing which has beensubmitted electronically in ASCII format and is hereby incorporated byreference in its entirety. Said ASCII copy, created on Nov. 30, 2020 isnamed “50971-007004_Sequence_Listing_11_30_2020_5 T25” and is 2,969bytes in size.

This invention relates to the use of serotonin 5-HT_(2A) receptoragonists at low dosages no greater than about 5 nM, more preferably nogreater about 1 nM, to treat tumor necrosis factor-alpha (TNF-α) relatedinflammation and inflammation-related diseases and conditions.

Serotonin 5-hydroxytryptamine (5-HT) receptors and agonists. Serotonin,5-hdroxytryptamine (5-HT), is a small monoamine molecule primarily knownfor its role as a neurotransmitter. Within the brain, 5-HT modulates avariety of behaviors including cognition, mood, aggression, mating,feeding, and sleep (Nichols and Nichols, 2008). These behaviors aremediated through interactions at seven different receptor families(5-HT_(1_7)) comprised of fourteen distinct subtypes (Nichols andNichols, 2008). Each of these are G-protein coupled receptors, with theexception of the 5-HT₃ receptor, which is a ligand-gated ion channel. Ofall the serotonin receptors, the 5-HT_(2A) receptor, which is known toprimarily couple to the Gαq effector pathway (Roth et al., 1986), hasbeen the one most closely linked to complex behaviors. There is a highlevel of expression of 5-HT_(2A) receptors within the frontal cortex,with significant localization to the apical dendrites of corticalpyramidal cells (Willins et al., 1997), and further expression at lowerlevels throughout the brain (Nichols and Nichols, 2008). These receptorshave been shown to participate in processes such as cognition andworking memory, have been implicated in affective disorders such asschizophrenia, and have been shown to mediate the primary effects ofhallucinogenic drugs (Nichols, 2004).

In addition, many peripheral tissues express 5-HT_(2A) receptors. Withinthe vasculature, 5-HT_(2A) receptors are known to modulatevasoconstriction (Nagatomo et al., 2004). Its role in other tissues suchas mesangial cells of the kidney, fibroblasts, liver, and lymphocytesremains less defined, but has been linked to cellular proliferation anddifferentiation.

The presence of 5-HT_(2A) receptor mRNA (along with the mRNAs of otherserotonin receptor subtypes) has been found in tissues involved in theimmune response (Stefulj et al., 2000). The role of 5-HT_(2A) receptorsin inflammatory processes, however, is unclear, with only a fewpublished and inconsistent reports. For example, blockage of 5-HT_(2A)receptor function with the selective antagonist sarpogrelate has beenreported to decrease expression of proinflammatory markers (Marconi etal., 2003; Akiyoshi et al., 2006), and conversely reported to increasedexpression of proinflammatory markers (Ito et al., 2000). Usingextremely high non-pharmacologically relevant drug doses (lowest dosewas 25 μM), a 5-HT₂ receptor specific agonist,1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane (DOI; the racemic form),was alleged to repress IL-1β expression and production of TNF-α due tolipopolysaccharide stimulation through 5-HT_(2A) receptor activation(Cloez-Tayarani et al., 2003).

Two other studies reported that DOI acting at 5-HT₂ receptors partiallyblocked LPS and cytokine stimulated nitrite accumulation using acocktail of TNF-α and INF-γ in C6 glioma cells, and reported an IC50value of 8±3 nM. (Miller et al., 1997; Miller and Gonzalez, 1998). Inearlier reports, the synthesis of TNF-α in response to LPS stimulationof toll-like receptors was reported to be inhibited by 5-HT through5-HT₂ receptors in monocytes (Arzt et al., 1991). The use of ketanserinas the antagonist to block 5-HT₂ receptor activation in many of thesestudies to indicate 5-HT_(2A) receptor involvment is problematic, sinceketanserin has only weak selectivity (˜20-fold) for 5-HT_(2A) receptorsover 5-HT_(2C) receptors, and has a high affinity for ai-adrenergicreceptors, and significantly, is equipotent at blocking histamine Hireceptors, which are known to regulate inflammatory processes.Ketanserin cannot be used to discriminate reliably between the effectsof agonists acting at 5-HT_(2A) or 5-HT_(2C) receptors.

The presence of serotonin itself has been demonstrated to be necessaryfor expression of the inflammatory markers IL-6 and TNF-α, with lowerserotonin levels inducing, and higher levels decreasing expression ofthese markers (Kubera et al., 2005). This inverted-U shaped responseclearly indicates that in vivo serotonin plays an important role inmodulating molecular components of the inflammatory process. Theidentity of the serotonin receptor mediating these processes has notbeen reliably established.

Primary cultures of rat aortic smooth muscle (RASM) are a wellestablished system to study inflammatory processes. Aortic smooth musclecells normally form the media of the aorta, and serve to provide andregulate vascular tone of the artery. Significantly, thepathophysiological status of vascular smooth muscle cells is a crucialdeterminant of vascular disease (Hansson et al., 2006). During thedevelopment of atherosclerosis, which is believed to have a majorinflammatory component, levels of cytokines such as TNF-α are elevated,leading to increased expression of genes and proteins, e.g., ICAM-1 andVCAM-1, in aortic smooth muscle (Blankenberg et al., 2003; Hansson etal., 2006). ICAM-1 (CD 54) belongs to the immunoglobulin (IgG)superfamily and is expressed in many cell types, including vascularendothelial cells, epithelial cells, fibroblasts, and macrophages(Hughes et al., 2000). Cytokine-mediated increased levels ofintracellular adhesion molecules like ICAM-1 in aortic smooth muscleserve as an important component of atherosclerotic plaque formation.

The Immune Response System in Mammals. There are two immune responsesystems in mammals. One is an innate immunity, and is the system wherebythe organism recognizes acute pathogens like invading bacteria. Thereare specific receptors on cells within the organism known as “Toll-likereceptors” (TLRs) that are pattern recognition receptors that recognizeantigens present on pathogenic micro-organisms. When a cell encountersthese pathogens, TLRs are activated by antigens on the pathogen. Thisactivation induces an inflammatory response which partially involves theactivation of Nuclear Factor k-B (NFkB), and transcription ofproinflammatory genes including cytokines and cell adhesion molecules.Activation of TLRs, primarily on monocytes and macrophage cells, withbacterially derived agents like lipopolysaccharide (LPS) induces theproduction and release of large amounts of tumor necrosis factor-alpha(TNF-α) from the monocyte and macrophage cells.

Tumour necrosis factor-alpha (TNF-α) is an inflammatory cytokineproduced by circulating monocytes and resident macrophages during acuteinflammation. Macrophages are, upon stimulation, the main producers ofTNF-α as well as they are also the primary infiltrating cells at thesite of inflammation. After TNF-α is released from these cells, oneaction is to bind to its specific receptor proteins (TNFR1 and TNFR2)present on the surface of almost every cell type. TNF-α receptors(TNFRs) are members of a different class of receptor proteins than TLRs,and recognize the endogenously produced cytokine TNF-α. Whereas TNF-α ispredominantly produced and released from circulating monocytes andresident macrophages at the site of infection or injury, TNF-α receptorsare expressed in nearly every cell. Through a very different signalingpathway from that used by TLR receptors, a pathway that involvescompletely different proteins, TNF-α receptor stimulation can lead toactivation and nuclear translocation of NF-kB, and transcription ofproinflammatory genes including cytokines and cell adhesion molecules.

When TNF-α binds to its specific receptor, a diverse range of signaltransduction events are initiated from the activated receptor that leadto cellular responses, which include responses like inflammation,necrosis, apoptosis, cell survival, and cell migration. During acuteinflammation, TNF-α overproduction is crucial in the induction ofinflammatory genes, cell death, endothelial up-regulation, and in therecruitment and activation of immune cells. TNF is a “master” cytokinein inflammatory diseases. Anti-TNF agents have been very effective inchronic inflammatory conditions in patients such as rheumatoidarthritis, even in the absence of other anti-cytokine agents.(Crisafulli et al 2009).

Whereas production and release of TNF-α from monocytes and macrophagescan be induced by TLRs during the process of infection, there are manyother mechanisms independent of TLRs that can regulate TNF-αconcentrations. For example, oxidative stress in cells can lead toelevated levels of TNF-α, as well as direct activation of NFkB, toproduce inflammation. Oxidative stress can be caused by pathologicalconditions that include diabetes, metabolic disorder, and neurologicaldisorders, and the resulting increase in inflammation can contribute tothe development and progression of diseases like atherosclerosis,arthritis, and asthma.

TNF-α and TNF-α receptor-mediated inflammatory pathways have beenstrongly implicated in a number of diseases including atherosclerosis,rheumatoid arthritis, psoriasis, type II diabetes, irritable bowelsyndrome, Crohn's disease, and septicemia (e.g., Reimold, 2002; Popa etal., 2007; Williams et al., 2007). Significantly, TNF-α and othercytokine induced inflammatory pathways also have been linked topsychiatric conditions such as depression and bipolar disorder (Dunn etal., 2005; Kim et al., 2007), as well as schizophrenia (Saetre et al.,2007), and neurodegenerative diseases like Alzheimer's and Parkinson'sdisease and stroke (Tweedie et al., 2007). As such, inhibitors ofTNF-α-mediated proinflammatory pathways represent potential therapeuticsfor each of these conditions. Currently, the only available therapeuticinhibitors of TNF-α pathways are monoclonal antibodies against TNF-α(infliximab and adalimumab) and soluble TNF-α receptor (etanercept), andthe development of small molecules for this purpose is highly desirable(Tracey et al., 2007).

Potential therapeutic strategies aimed at blocking TNF-α synthesis andrelease would primarily target the monocytes and macrophage cells. Incontrast, therapeutic strategies that are aimed at blocking the TNF-αreceptor-induced signal transduction pathways by 5-HT_(2A) receptoractivity would aim at any tissue cell expressing TNF-α receptors, whichinclude most cell types in the body (e.g. smooth muscle cells, neurons,skin cells).

DISCLOSURE OF INVENTION

We have shown that activation of 5-HT_(2A) receptors using agonists atconcentrations no greater than 5 nm, more preferably no greater than 1nM, potently inhibits TNF-α-induced inflammation in multiple cell types,including rat aortic smooth muscle cells, human neuroblastoma cells, ratglioma cells, rat aortic epithelial cells, and rat bronchoaveolarmacrophage cells. We have shown that 5-HT_(2A) receptor stimulation withthe agonist (R)-DOI rapidly inhibits a variety of proinflammatorymarkers mediated by TNF-α acting at its receptors, including ICAM-1,VCAM-1, and IL-6 gene expression, NOS activity, and nucleartranslocation of NF-κB, with IC50 values of only 10-20 pM.Significantly, proinflammatory markers also can be inhibited by (R)-DOImany hours after treatment with TNF-α. With the exception of a fewnatural toxins, no current drugs or small molecule therapeuticsdemonstrate a comparable potency for any physiological effect.TNF-α-mediated inflammatory pathways have been strongly implicated in anumber of diseases, including atherosclerosis, rheumatoid arthritis,asthma, psoriasis, type II diabetes, depression, schizophrenia, andAlzheimer's disease. Our results indicate that activation of 5-HT_(2A)receptors represents an extraordinarily potent, potential therapeuticavenue for the treatment of disorders involving TNF-α-mediatedinflammation. Importantly, because (R)-DOI can significantly inhibit theeffects of TNF-α many hours after the administration of TNF-α, potentialtherapies could be aimed not only at preventing inflammation, but alsotreating inflammatory injury that has already occurred or is ongoing.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1A illustrates the effect of 5-HT_(2A) receptor activation with theagonist (R)-DOI on the expression of ICAM-1 in primary rat aortic smoothmuscle cells (passage 4). The Y-axis represents percent of TNF-α controlinduction for the dose of (R)-DOI indicated on the X-axis. The IC₅₀ forproinflammatory gene expression inhibition for ICAM-1 is 19.5 pM.

FIG. 1B illustrates the effect of 5-HT_(2A) receptor activation with theagonist (R)-DOI on the expression of VCAM-1 in primary rat aortic smoothmuscle cells (passage 4). The Y-axis represents percent of TNF-α controlinduction for the dose of (R)-DOI indicated on the X-axis. The IC₅₀ forproinflammatory gene expression inhibition for VCAM-1 is 12.0 pM.

FIG. 1C illustrates the effect of 5-HT_(2A) receptor activation with theagonist (R)-DOI on the expression of IL-6 in primary rat aortic smoothmuscle cells (passage 4). The Y-axis represents percent of TNF-α controlinduction for the dose of (R)-DOI indicated on the X-axis. The IC50 forproinflammatory gene expression inhibition for IL-6 is 10.3 pM.

FIG. 1D illustrates the effect of 5-HT_(2A) receptor activation with theagonist (R)-DOI on the expression of ICAM-1 in primary rat aortic smoothmuscle cells (passage 4) in serum-free media. The Y-axis representspercent of TNF-α control induction for the dose of (R)-DOI indicated onthe X-axis. The IC50 for proinflammatory gene expression inhibition forICAM-1 in serum-free media is 360 pM.

FIG. 2A illustrates the effect of 5-HT_(2A) receptor activation on theexpression of ICAM-1 in primary rat aortic smooth muscle cells (passage4) under various conditions: control, TNF-α treatment alone (10 ng/ml)(TNF), pre-treatment with (R)-DOI (1 nM) prior to TNF-α (DOI+TNF),pretreatment with the 5-HT_(2A) receptor selective antagonist M100907(100 nM) 30 minutes prior to (R)-DOI (M+D+T), pretreatment with 100 nMof the 5-HT_(2B) receptor selective antagonist SB204741 30 minutes priorto (R)-DOI (S+D+T), or pretreatment with 100 nM of the 5-HT_(2C)receptor selective antagonist RS102221 30 minutes prior to (R)-DOI(R+D+T). (# p<0.01 vs control; * p<0.01 vs TNF-α alone; ANOVA with Tukeypost hoc)

FIG. 2B illustrates the effect of 5-HT_(2A) receptor activation on theexpression of VCAM-1 in primary rat aortic smooth muscle cells (passage4) under various conditions: control, TNF-α treatment alone (10 ng/ml)(TNF), pre-treatment with (R)-DOI (1 nM) prior to TNF-α (DOI+TNF),pretreatment with the 5-HT_(2A) receptor selective antagonist M100907(100 nM) 30 minutes prior to (R)-DOI (M+D+T), pretreatment with 100 nMof the 5-HT_(2B) receptor selective antagonist SB204741 30 minutes priorto (R)-DOI (S+D+T), or pretreatment with 100 nM of the 5-HT_(2C)receptor selective antagonist RS102221 30 minutes prior to (R)-DOI(R+D+T). (# p<0.01 vs control; * p<0.01 vs TNF-α alone; ANOVA with Tukeypost hoc)

FIG. 2C illustrates the effect of 5-HT_(2A) receptor activation on theexpression of IL-6 in primary rat aortic smooth muscle cells (passage 4)under various conditions: control, TNF-α treatment alone (10 ng/ml)(TNF), pre-treatment with (R)-DOI (1 nM) prior to TNF-α (DOI+TNF),pretreatment with the 5-HT_(2A) receptor selective antagonist M100907(100 nM) 30 minutes prior to (R)-DOI (M+D+T), pretreatment with 100 nMof the 5-HT_(2B) receptor selective antagonist SB204741 30 minutes priorto (R)-DOI (S+D+T), or pretreatment with 100 nM of the 5-HT_(2C)receptor selective antagonist RS102221 30 minutes prior to (R)-DOI(R+D+T). (# p<0.01 vs control; * p<0.01 vs TNF-α alone; ANOVA with Tukeypost hoc)

FIG. 3 illustrates the effect of 5-HT_(2A) receptor activation on theexpression o ICAM-1 in primary rat aortic smooth muscle cells (passage4) under various conditions: control; TNF-α treatment alone (10 ng/ml)(TNF-α); pretreatment with (R)-DOI (1 nM, a 5-HT_(2A) receptor agonist)prior to TNF-α (DOI+TNF-α), pretreatment with the phenethylamine 2C-BCB(1 nM and 50 nM, a 5-HT_(2A) receptor agonist) prior to TNF-α(2C-BCB+TNF-α); pretreatment with the indolealkylamine LA-SS-Az (1 nMand 50 nM, a 5-HT_(2A) receptor agonist) prior to TNF-α(LA-SS-Az+TNF-α); and pretreatment with the indolealkylamine LSD (1 nMand 50 nM, a 5-HT_(2A) receptor agonist) prior to TNF-α (LSD+TNF-α).

FIG. 4 illustrates the effect of 5-HT_(2A) receptor activation on theexpression o ICAM-1 in primary rat aortic smooth muscle cells (passage4) under various conditions: control; TNF-α treatment alone (10 ng/ml)(TNF-α); pretreatment with (R)-DOI (1 nM, a 5-HT_(2A) receptor agonist)prior to TNF-α (D+T), pretreatment with the pan-PKC isoform inhibitorchelerythrine (100 nM) for 30 minutes prior to the addition of (R)-DOI(1 nM) prior to TNF-α (C+D+T); pretreatment with the classical PKCisoform inhibitor Gö6976 (100 nM) for 30 minutes prior to the additionof (R)-DOI (1 nM) prior to TNF-α (Go+D+T); pretreatment with a PKCactivator PMA (100 nM) prior to TNF-α (PMA+T); and pretreatment with aPKA inhibitor F-22 amide (100 nM) for 30 minutes prior to the additionof (R)-DOI (1 nM) prior to TNF-α (F-22+D+T). (*=p<0.01 vs control; ANOVAwith Tukey post hoc).

FIG. 5 illustrates a time course study examining 5-HT_(2A) receptorsimulation by (R)-DOI (1 nM) and its effect in inhibiting TNF-α-inducedICAM1 expression when given at various time intervals after addition ofTNF-α (10 ng/ml) (in minutes) in primary rat aortic smooth muscle cells(passage 4).

FIG. 6 illustrates the effect of 5-HT_(2A) receptor activation on thelevels of nitrite (an indicator of NOS activity) in primary rat aorticsmooth muscle cells (passage 4) under various conditions: control; TNF-αtreatment alone (10 ng/ml) (TNF-α); pretreatment with (R)-DOI (1 nM)prior to TNF-α (DOI+T), and pretreatment with the pan-PKC isoforminhibitor chelerythrine (100 nM) 30 mins prior to pretreatment with(R)-DOI (1 nM) prior to TNF-α (Che+D+T) (*=p<0.01 vs. TNF-α; ANOVA withTukey post hoc).

FIG. 7A illustrates both the p65 localization as visualized withAlexafluor 48 conjugated secondary antibody (the top row), and theposition of the nuclei as visualized with DAPI (the bottom row) inprimary rat aortic smooth muscle cells (passage 4) under variousconditions: control; TNF-α treatment alone (10 ng/ml) (TNF-α); andpretreatment with (R)-DOI (1 nM) prior to TNF-α (TNF-α+(R)-DOI).

FIG. 7B illustrates the percentage of cells within a given field thatpredominantly showed p65 located in the nucleus under variousconditions: control; (R)-DOI alone (1 nM); TNF-α treatment alone (10ng/ml) (TNF-α); and pretreatment with (R)-DOI (1 nM) prior to TNF-α((R)-DOI+TNF-α). (Average of three fields for each treatment; * p<0.01vs. control, # p<0.01 vs TNF-α, ANOVA with Tukey post hoc).

FIG. 8 illustrates the effect of 5-HT_(2A) receptor activation with theagonist 0-DOI on the expression of ICAM-1 in human neuroblastoma cells.The Y-axis represents percent of TNF-α control induction for the dose of(R)-DOI indicated on the X-axis. The IC50 for proinflammatory geneexpression inhibition for ICAM-1 is about 0.8 nM.

FIG. 9 illustrates the effect of 5-HT_(2A) receptor activation on theexpression of ICAM-1 in rat C6 glioma cells under various conditions:control; TNF-α treatment alone (10 ng/ml) (TNF); pretreatment with(R)-DOI (1 nM and 50 nM, a 5-HT_(2A) receptor agonist) prior to TNF-α(DOI), and pretreatment with the indolealkylamine LA-SS-Az (1 nM and 50nM, a 5-HT_(2A) receptor agonist) prior to TNF-α (LA-SS-Az).

FIG. 10 illustrates the effect of 5-HT_(2A) receptor activation with theagonist 0-DOI on the expression of VCAM-1 in primary rat bronchoaveolarmacrophage cells. The Y-axis represents percent of TNF-α controlinduction for the dose of (R)-DOI indicated on the X-axis. The IC50 forproinflammatory gene expression inhibition for VCAM-1 is about 20 pM.

FIG. 11A illustrates the effect of 5-HT_(2A) receptor activation on theexpression of IL-6 in rat primary aortic endothelial cells under variousconditions: control; TNF-α treatment alone (10 ng/ml) (TNF); andpretreatment with (R)-DOI (10 pM, a 5-HT_(2A) receptor agonist) 60minutes prior to TNF-α (DOI).

FIG. 11B illustrates the effect of 5-HT_(2A) receptor activation on theexpression of VCAM-1 in rat primary aortic endothelial cells undervarious conditions: control; TNF-α treatment alone (10 ng/ml) (TNF); andpretreatment with (R)-DOI (10 pM, a 5-HT_(2A) receptor agonist) 60minutes prior to TNF-α (DOI).

FIG. 12 illustrates the effect of 5-HT_(2A) receptor activation on theexpression of ICAM-1 due to stimulation with lipopolysaccharide (LPS,100 ng and 1 μg) in primary rat aortic smooth muscle cells (passage 4)under various conditions: control; LPS treatment alone (100 ng and 1μg); pretreatment with (R)-DOI (100 nM, a 5-HT_(2A) receptor agonist)prior to LPS treatment (LPS+DOI).

Current anti-inflammatory agents directly target other pathways, forexample, the inhibition of prostaglandin synthesis or production ofcytokines. Most published reports probing the role of serotonin 5-HT₂receptors in inflammation have primarily focused on the use ofantagonists (blockers) as anti-inflammatory agents. We have shown thatthe use of serotonin 5-HT_(2A) receptor agonists (activators) atextremely low concentration, e.g., (R)-DOI, inhibits inflammatory markergene expression with a potency at least 100 times greater than anycurrent drug on the market. This allows for the treatment ofinflammatory diseases and conditions with small doses of drug, whichwould decrease the likelihood of undesirable side effects. At the dosesof drug found effective in this technology, inflammation processes couldbe targeted very specifically with little to no undesirable side effectsdue to off target receptor activation.

We have discovered that activation of 5-HT_(2A) receptors in primaryaortic smooth muscle cells provides a previously unknown and extremelypotent inhibition of TNF-α-mediated inflammation. 5-HT_(2A) receptorstimulation with the agonist (R)-DOI rapidly inhibits a variety ofproinflammatory markers mediated by TNF-α acting at its receptors,including ICAM-1, VCAM-1, and IL-6 gene expression, NOS activity, andnuclear translocation of NF-κB, with IC50 values of only 10-20 pM.Significantly, proinflammatory markers also can be inhibited by (R)-DOImany hours after treatment with TNF-α. With the exception of a fewnatural toxins, no current drugs or small molecule therapeuticsdemonstrate a comparable potency for any physiological effect.TNF-α-mediated inflammatory pathways have been strongly implicated in anumber of diseases, including atherosclerosis, asthma, rheumatoidarthritis, psoriasis, type II diabetes, depression, schizophrenia, andAlzheimer's disease. Our results indicate that activation of 5-HT_(2A)receptors represents an extraordinarily potent, potential therapeuticavenue for the treatment of disorders involving TNF-α-mediatedinflammation. Importantly, because (R)-DOI can significantly inhibit theeffects of TNF-α many hours after the administration of TNF-α, potentialtherapies could be aimed not only at preventing inflammation, but alsotreating inflammatory injury that has already occurred or is ongoing.

EXAMPLE 1

Material and Methods.

Reagents and Chemicals. Standard cell culture media (M-199) was providedby the Molecular and Cell core at Louisiana State University HealthScience Center in New Orleans (LSUHSC-NO). Supplements to the media werefrom Invitrogen (Carlsbad, Calif.). TNF-α (rat and human) was purchasedfrom Peprotech, Inc. (Rocky Hill, N.J.). The 5-HT_(2C) receptorantagonist RS102221(8-[5-(2,4-Dimethoxy-5-(4-trifluoromethylphenylsulphonamido)phenyl-5-oxopentyl]-1,3,8-triazaspiro[4.5]decane-2,4-dionehydrochloride), HT_(2B) receptor antagonist SB204741(N-(1-Methyl-1H-indolyl-5-yl)-N″-(3-methyl-5-isothiazolyl)urea, PKCinhibitor Gö6976(5,6,7,13-Tetrahydro-13-methyl-5-oxo-12H-indolo[2,3-a]pyrrolo[3,4-c]carbazole-12-propanenitrile),and PKC inhibitor chelerythrine(1,2-Dimethoxy-12-methyl[1,3]benzodioxolo[5,6-c]phenanth ridiniumchloride) were purchased from Tocris (Ellisville, Mo.). PKC activatorPMA (Phorbol 12-myristate 13-acetate), and PKA inhibitor fragment 6-22amide (F-22) were purchased from Sigma (St. Louis, Mo.). (R)-DOI((R)-1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane) (greater than 95% Renantiomer), LA-SS-Az(2'S,4'S)-(+)-9,10-Didehydro-6-methylergoline-8β-(trans-2,4-dimethylazetidide),2C-BCB (4-Bromo-3,6-dimethoxybenzocyclobuten-1-yl) methylamine, andMDL100907(R(+)-a-(2,3-dimeth-oxyphenyl)-1-[2-(4-fluorophenylethyl)]-4-pipeddine-methanol)were obtained from Purdue University. Lysergic acid diethylamide (LSD)was provided by the National Institute on Drug Abuse.

RASM cells and treatment. Rat aortic smooth muscle (RASM) cells wereisolated from adult 180 g male Sprague-Dawley rats and provided by theCell and Molecular Core Facility in the Department of Pharmacology atLSUHSC-NO. Isolated RASM cells were grown in M-199 media containing 10%fetal bovine serum (Gibco), 100 units/mL penicillin, and 100 g/mLstreptomycin, and incubated at 37° C. in 5% CO2. Cells for all assayswere used between passages 3 and 5. Prior to treatments, cells weregrown in M-199 media with 10% fetal bovine serum (FBS) until 30-50%confluent. For most assays, cells were treated with (R)-DOI, or otherdrugs as indicated, at specific concentrations for 24 hours, followed byTNF-α (10 ng/ml) and (R)-DOI at the same pretreatment concentrations infresh M-199 media. After another 24 hours, the cells were scraped,pelleted, and processed for RNA. Pretreatment and treatment times variedwith assays as indicated in the results section.

RNA isolation and Quantitative Realtime-PCR. RNA was extracted fromcells using Illustra RNAspin Mini kits from GE Healthcare Life Sciences(Piscataway, N.J.) following protocols supplied by the manufacturer.First strand cDNA was generated using the ImProm-II cDNA synthesis kit(Promega) following the manufacturers protocols. Q-RT-PCR was performedusing the ProbeLibrary system from Roche (Indianapolis, Ind.) incombination with the HotStart-IT probe qper master mix from USBBiological (Cleveland, Ohio) following manufactures protocols.

The sequences of primers used are: 5-HT_(2A)R (5-hydroxytryptamine 2Areceptor): forward primer 5′-TGATGTCACTTGCCATAGCTG-3′ (SEQ ID NO: 1),reverse primer, 5′TCGCACAGAGCTTGCTAGG-3′ (SEQ ID NO: 2); ICAM-1(intracellular adhesion molecule 1): forward primer,5′-TTCTGCCACCATCACTGTGT-3′ (SEQ ID NO: 3, reverse primer,5′-AGCGCAGGATGAGGTTCTT-3′ (SEQ ID NO: 4); VCAM-1 (vascular adhesionmolecule 1): forward primer, 5′-CAAATGGAGTCTGAACCCAAA-3′ (SEQ ID NO: 5),reverse primer, 5′-GGTTCTTTCGGAGCAACG-3′ (SEQ ID NO: 6); IL-6(interleukin-6): forward primer, 5′-CCTGGAGTTTGTGAAGAACAACT-3′ (SEQ IDNO: 7), reverse primer, 5′-GGAAGTTGGGGTAGGAAGGA-3′ (SEQ ID NO: 8); andcyclophillin B (control amplicon): forward primer,5′-ACGTGGTTTTCGGCAAAGT-3′ (SEQ ID NO: 9), reverse primer,5′-CTTGGTGTTCTCCACCTTCC-3′ (SEQ ID NO: 10). Primers were synthesized byIDT (Coralville, Iowa). ProbeLibrary probes from Roche were: U3, U74,U13, U106, U79 for 5-HT_(2A)R, ICAM-1, VCAM-1, IL-6, and cyclophillin B,respectively. Quantitative determination of gene expression levels usinga 2-step cycling protocol was performed on a MyIQ-5 Cycler (Bio-Rad,Hercules Calif.). Relative gene expression levels were calculated usingthe 2^([−ΔΔC(T)]) method. Levels of all targets from the test sampleswere normalized to rat cyclophillin B expression.

Nitric Oxide Synthetase (NOS) Activity. NOS activity was determined bydetection of nitrite levels in the cell culture medium following(R)-DOI/TNF-α treatments utilizing the Nitrate Detection kit from AssayDesigns (Ann Arbor, Mich.) following the manufacturers protocols.Absorbances were detected at 539 nm on a Molecular Dynamics SpectraMaxM2 plate reader.

Nuclear Translocation of p65. RASM cells were grown in M-199 medium+10%FBS until 50% confluent in 8 well chamber slides. Cells were treatedwith 1 nM (R)-DOI for various times as indicated, and TNF-α (10 ng/ml;tumor necrosis factor alpha) added. Thirty minutes after TNF-αtreatment, cells were fixed and processed with rabbit anti p65 primaryand Alexafluor 488-conjugated goat secondary antibodies as described inZerfaoui et al. (2008) (Zerfaoui et al., 2008). Fluorescent signal wasvisualized on a Leica DMRA2 fluorescent microscope.

EXAMPLE 2

(R)-DOI Super-Potently Inhibits TNF-α Induced Expression ofProinflammatory Genes.

Primary rat aortic smooth muscle (RASM) cells were verified to express5-HT_(2A) mRNA by QRT-PCR using primer sequences and probe as describedin the methods section of Example 1 (data not shown). To examine theeffects of 5-HT_(2A) receptor activation on TNF-α-mediatedproinflammatory gene expression, RASM cells were pretreated with(R)-DOI, a selective 5-HT₂ receptor agonist, as described above.Dose-response curves were determined for the effects on ICAM-1, VCAM-1,and IL-6 gene expression for twelve different concentrations of (R)-DOIranging from 0.1 pM to 100 nM, with each experiment repeated intriplicate. The results are shown in FIGS. 1A, 1B, and 1C. In FIGS.1A-1C, the Y-axis represents a percent of TNF-α for the dose of (R)-DOIindicated on the X-axis. The IC₅₀ for proinflammatory gene expressioninhibition is between 10-20 pM for all three (ICAM-1=19.5 pM;VCAM-1=12.0 pM; IL-6=10.3 pM). This indicates that (R)-DOI is asurprisingly super-potent inhibitor of each of these genes with an IC50in the picomolar range.

The experiments were repeated with fresh dilutions of drug and differentbatches of RASM cells, with the same results: a super-potent effect.TNF-α alone consistently increased baseline mRNA expression of thesegenes eight-ten fold, whereas (R)-DOI had no effect by itself (Data notshown).

Because complete media with FBS contains serotonin, which may affect theresults, the effects of (R)-DOI on TNF-α-induced ICAM1 expression wereexamined in cells serum starved for 8 hours. FIG. 1D shows an ICAM1expression dose response curve in serum-free media. The IC₅₀ increasedslightly to 360 pM over that seen in the experiments with FBS. Allexperiments were performed in RASM cells at passage 4. (FIG. 1D).

Non-steroidal anti-inflammatories (NSAIDS) typically have IC50 values inthe micromolar range for their targets, whereas steroidalanti-inflammatory drugs typically have IC50 values in the low nanomolarrange (Huntjens et al., 2005). The IC50 values in the low picomolarrange for (R)-DOI to block proinflammatory markers show that (R)-DOIactivation of 5-HT_(2A) receptors is ˜300-fold more potent than the moreeffective current anti-inflamatory agents. With the exception of a fewnatural toxins (e.g. botulinum toxin), no current drugs or smallmolecule therapeutics demonstrate a comparable potency for anyphysiological effect.

EXAMPLE 3

Inhibition of Proinflammatory Markers Mediated Through 5-HT_(2A)Receptor Antivation.

Because (R)-DOI is an agonist at all three 5-HT₂ receptor isoforms,receptor selective antagonists were selected to determine which receptorwas mediating the (R)-DOI effect. RASM cells were treated with a controlsolution (Control), TNF-α alone (TNF-α), (R)-DOI alone (DOI),pretreatment with (R)-DOI (1 nM) prior to TNF-α (DOI+TNF), pretreatmentwith the 5-HT_(2A) receptor selective antagonist M100907 (100 nM) 30minutes prior to (R)-DOI and TNF-α (M+D+T), pretreatment with 100 nM ofthe 5-HT_(2B) receptor selective antagonist SB204741 prior to (R)-DOIand TNF-α (S+D+T), and pretreatment with 100 nM of the 5-HT_(2B)receptor selective antagonist SB204741 prior to (R)-DOI and TNF-α(S+D+T).

The results are shown in FIGS. 2A, 2B, and 2C for the induced expressionof ICAM-1, VCAM-1, and IL-6, respectively. TNF-α treatment alone (10ng/ml) (TNF-α) induced expression of ICAM-1, VCAM-1, and IL-6. (R)-DOIat 1 nM alone had no effect on expression of any of the three genes(DOI). Pre-treatment with (R)-DOI (1 nM) prior to TNF-α completelyblocked the increase in proinflammatory gene expression by TNF-α(DOI+TNF). Pretreatment with the 5-HT_(2A) receptor selective antagonistM100907 (100 nM) 30 minutes prior to (R)-DOI blocked the effects of(R)-DOI (M+D+T). Pretreatment with 100 nM of the 5-HT_(2B) receptorselective antagonist SB204741 (S+D+T), or the 5-HT_(2C) receptorselective antagonist RS102221 (R+D+T) did not block the effects of(R)-DOI. In FIGS. 2A, 2B, and 2C, the symbols represent the following:#=p<0.01 vs control; *=p<0.01 vs TNF-α alone as analyzed with an ANOVAwith Tukey post hoc)

As shown above, pretreatment of the cells with 100 nM of either the5-HT_(2C) receptor selective antagonist RS102221, or the 5-HT_(2B)receptor selective antagonist SB204741 for 30 minutes prior to theaddition of 1 nM (R)-DOI (a dose that completely inhibits TNF-α inducedproinflammatory gene expression) had no effect. Pretreatment with 100 nMof the 5-HT_(2A) receptor selective antagonist MDL100907 for 30 minutes,however, completely blocked the inhibitory effects of 1 nM (R)-DOI onTNF-α mediated ICAM-1, VCAM-1, and IL-6 gene expression changes (FIGS.2A, 2B, and 2C, respectively), indicating that the effects of (R)-DOI onthese processes are being mediated exclusively through the 5-HT_(2A)receptors.

EXAMPLE 4

Additional 5-HT_(2A) Receptor Agonists Inhibit Proinflamatory MarkerExpression.

To examine if these effects were exclusive for (R)-DOI acting at5-HT_(2A) receptors, other 5-HT_(2A) agonists were tested for ability toinhibit proinflamatory marker expression. These included an additionalphenethylamine, 4-Bromo-3,6-dimethoxybenzocyclobuten-1-yl) methylamine(2C-BCB), and two indolealkylamines,(2'S,4'S)-(+)-9,10-Didehydro-6-methylergoline-8β-(trans-2,4-dimethylazetidide)(LA-SS-Az) and lysergic acid diethylamide (LSD). All three have highaffinity for rat 5-HT_(2A) receptors (Ki of 2C-BCB=0.73 nM; LA-SS-Az=8.3nM; LSD=3.5 nM) as well as high potency for activating PI turnover (EC₅₀of 2C-BCB=36 nM; LA-SS-Az=19 nM; LSD=15 nM) (Nichols et al., 2002;McLean et al., 2006).

The phenethylamine 2C-BCB, and the indolealkylamines LA-SS-Az and LSD,were tested for their ability to block TNF-α-mediated increases inproinflammatory gene expression at both 1 nM and 50 nM concentrations.The results with ICAM1 are shown in FIG. 3. Results for VCAM1 and IL6were identical (Data not shown). Whereas (R)-DOI blocked gene expressionat 1 nM, 2C-BCB and LSD only had weak to moderate effects at 1 nM.LA-SS-Az was moderately effective at this dose and blocked about 50% ofinduced gene expression. At the higher concentration of 50 nM, 2C-BCBand LA-SS-Az effectively blocked TNF-α induced gene expression. However,LSD only blocked about 85% of the effect.

Thus, the effects at both 1 nM and 50 nM pretreatment on gene expressionof other 5-HT_(2A) receptor ligands show that they also may have potenteffects (FIG. 3). Whereas the effects are potent (predicted IC50 valuesin the low nanomolar range), they are not extraordinarily potent as isthe case for (R)-DOI. Based upon the affinity (a measure of how tightlya particular molecule attaches to its protein target) of (R)-DOI for thereceptor (Affinity=Ki=0.5 nM), and potency (a term relating to how muchof a drug is necessary to produce a half maximal response) of (R)-DOI instandard pharmacological assays that measure activity of the 5-HT_(2A)receptor (e.g. phosphoinositide turnover; EC50=−10-20 nM), which aresimilar to the affinity and potency values of other known 5-HT_(2A)receptor agonists including 2C-BCB and LSD, the extreme potency of(R)-DOI in blocking TNF-α mediated inflammation with an IC50 of ˜20picomolar, about 1000 times less than is necessary to produce a halfmaximal effect in standard pharmacological measures of 5-HT_(2A)receptor activity, is unpredicted and unexpected.

EXAMPLE 5

5-HT_(2A) Receptor Mediated Inhibition of TNF-α Induced ProinflammatoryMarker Expression Involves Protein Kinase C (PKC).

It has been well established that ICAM-1 gene expression can be inducedthrough pathways involving protein kinase C (PKC) (Roebuck and Finnegan,1999). Furthermore, PKC can be activated through 5-HT_(2A) receptorstimulation (Roth et al., 1986). To delineate the role of PKC, RASMcells were pretreated with several chemicals prior to treatment with(R)-DOI (1 nM) and TNF-α, and then measured for ICAM-1, VCAM-1, and IL-6gene expression. The results were identical for all three genes, and theresults for ICAM-1 are shown in FIG. 4. The results for the other twogenes are not shown.

The ICAM-1 gene expression was first measured using a control solution(control), only TNF-α (TNF-α), and pretreatment with (R)-DOI prior toTNF-α (D+T). Pretreatment with the pan-PKC isoform inhibitorchelerythrine (100 nM) for 30 minutes prior to the addition of (R)-DOI(1 nM) blocked the effects of TNF-α-induced gene expression for ICAM1(C+D+T). Pretreatment with the classical PKC isoform inhibitor Gö6976(100 nM) (Go+D+T) only blocked about 50% of the effects of (R)-DOI (1nM) on TNF-α-induced proinflammatory gene expression, indicating thatmore than one PKC isoform, at least one from each class, is mediatingthe anti-inflammatory effects of 5-HT_(2A) receptor stimulation.Activation of PKC with PMA (100 nM) in the absence of (R)-DOI alsoblocks the effects of TNF-α (PMA+T). Inhibition of PKA with F-22 amide(100 nM) had no effect (F-22+D+T). In FIG. 4, the symbol * represent*=p<0.01 vs control; as analyzed with ANOVA with Tukey post hoc. Theeffects of these PKC inhibitors were the same for VCAM1 and IL6 geneexpression (Data not shown). Together, these data indicate that the5-HT_(2A) receptor-mediated inhibitory effects on proinflammatory geneexpression are mediated through stimulation of PKC.

Thus, a pan-PKC isoform inhibitor, chelerythrine (100 nM), completelyinhibited the effects of 1 nM (R)-DOI on TNF-α-induced ICAM-1 geneexpression (FIG. 4), indicating that PKC plays a critical role in themechanism of action of 5-HT_(2A) receptor-mediated inhibition ofproinflammatory markers. To further delineate the role of specificisoforms of PKC in this process, RASM cells were pretreated with theconventional isoform inhibitor Gö6976 (100 nM) and tested the ability of(R)-DOI to inhibit TNF-α-induced proinflammtory marker expression. Only50% of the effect of (R)-DOI was blocked, indicating that 5-HT_(2A)receptor stimulated anti-inflammatory effects are mediated through atleast two isoforms of PKC: one conventional, and one non-conventional(FIG. 4). Finally, the ability of exogenous activation of PKC wasexamined using Phorbol 12-myristate 13-acetate (PMA) in RASM cells toblock the effects of TNF-α on proinflammatory marker expression. In theabsence of (R)-DOI, PMA (100 nM) was found to completely block TNF-αmediated expression of ICAM1, VCAM1, and IL6 (FIG. 4, results for ICAM1.Data are not shown for VCAM1 and IL6). If the effects are completelymediated through PKC, inhibiting other GPCR initiated effector pathwayslike PKA would have no effect. Indeed, when the effects of blocking PKAwith the inhibitor F-22 amide (100 nM) was tested on the ability of(R)-DOI to block TNF-α on proinflammatory marker expression, no effectwas observed (FIG. 4).

EXAMPLE 6

Effects of (R)-DOI at Blocking Proinflammatory Gene Expression is Rapid,and Present Many Hours after Addition of TNF-α

The initial dose response experiments examined the effects of 24 hourpretreatment with (R)-DOI. To determine whether this length ofpretreatment was necessary to block the effects of TNF-α, a time courseanalysis was performed to examine the ability of (R)-DOI (1 nM) to blockthe effects of TNF-α (10 ng/ml) on ICAM-1 gene expression with 24 hourand one hour pretreatments, simultaneous treatment, and various timepoints after treatment with TNF-α. The 24 hour and one hourpretreatments, and simultaneous treatment with (R)-DOI completelyblocked the effects of TNF-α (Data not shown). These data indicated that(R)-DOI very rapidly blocks proinflammatory marker expression.

FIG. 5 shows a time course study examining when 5-HT_(2A) receptorstimulation is necessary to inhibit TNF-α-induced ICAM1 expression inRASM cells. (R)-DOI (1 nM) can block TNF-α-induced proinflammatory geneexpression after addition of TNF-α (10 ng/ml) with a half maximal effectat 4 hours. Significantly, the addition of (R)-DOI after TNF-α treatmentsubstantially blocked ICAM-1 expression with a 50% effect at about 4hours (FIG. 5).

The activation of 5-HT_(2A) receptors by (R)-DOI blocks not only theeffects of TNF-α when added as a pre- or co-treatment, but also whenadded many hours after TNF-α treatment with a half maximal effect at 4hours post-TNF-α.

EXAMPLE 7

Nitric Oxide Synthase (NOS) Activity is Inhibited by 5-HT_(2A) ReceptorActivation with (R)-DOI.

A key participant in inflammatory processes is NOS activity (Guzik etal., 2003). NOS activity can regulate NF-kB activation (Ckless et al.,2007), and cytokine pathway-activated NF-kB can transcriptionallyregulate iNOS gene expression (Guo et al., 2007). To examine the effectsof 5-HT_(2A) receptor activation on this component of inflammatorymechanisms, primary RASM cells were used to examine the ability of 1 nM(R)-DOI to block TNF-α mediated increases in nitrite levels.

As an indicator of NOS activity, nitrite levels were measured in thecell culture media after treatments and are shown in FIG. 6 as %control. TNF-α treatment (10 ng/ml) for 24 hours significantly increasednitrite levels eight-fold, indicating increased NOS activity.Pretreatment with 1 nM (R)-DOI for 24 hours blocked TNF-α mediatedincreases in nitrite accumulation (DOI+T). Pretreatment with the pan-PKCisoform inhibitor chelerythrine (100 nM) completely inhibited theeffects of (R)-DOI (Che+D+T) (*=p<0.01 vs. TNF-α; ANOVA with Tukey posthoc). These results indicate that PKC activation is upstream of NOSactivity.

EXAMPLE 8

Nuclear Translocation of the Activated NF-κB Subunit p65 is Blocked by5-HT_(2A) Receptor Activation with (R)-DOI.

Both ICAM-1 and VCAM-1 gene transcription during inflammatory processesis regulated by the transcription factor NF-κB (Collins et al., 1995).During this process, NF-κB must be activated, and then translocated fromthe cytoplasm to the nucleus, where it promotes gene transcription. Toinvestigate whether 5-HT_(2A) receptor stimulated inhibition of NF-κBactivation and translocation might be a possible mechanism for blockadeof proinflammatory gene expression changes, a series ofimmunohistochemical experiments were conducted examining p65translocation in RASM cells. TNF-α treatment for 30 minutes caused theexpected dramatic shift in localization of the p65 subunit of NF-κB fromthe cytoplasm to the nucleus (FIG. 7A). Pretreatment with 1 nM (R)-DOIfor 24 hours (not shown), one hour, and together (not shown) with TNF-α(10 ng/ml) completely blocked p65 nuclear translocation (FIG. 7B). FIG.7B shows the percentage of cells within a given field that predominantlyhad p65 located in the nucleus. Furthermore, pretreatment of the 1 hourtime point with the PKC inhibitor chelerythrine blocked the (R)-DOIinduced inhibition of p65 translocation (not shown), indicating that PKCactivation is upstream of this process. The ability of (R)-DOI to blocktranslocation when administered simultaneously with TNF-α, and not as apretreatment, is in agreement with the above time course gene expressionstudies, and further supports that the effects of 5-HT_(2A) receptorstimulation on inhibiting inflammatory processes are very rapid.

EXAMPLE 9

5-HT_(2A) Receptor Activation Potently Blocks Proinflammatory MarkerExpression in Different Cell Types.

Experiments were conducted to analyze for the effect of 5-HT_(2A)receptor activation on proinflammatory marker expression in other celltypes. Human neuroblastoma cells (SHSY5Y) and rat glioma cells (C6) canbe obtained from the American Type Culture Collection (Manassas, Va.),but were provided Purdue University. The cells were grown in DMEM+10%FBS. DMEM was made and provided by the Cell and Molecular Core of theMentoring in Cardiovascular Biology COBRE center at LSUHSC-NO. FBS waspurchased from Invitrogen (Carlsbad, Calif.). Primary rat aorticendothelial cells were prepared fresh and provided by the Cell andMolecular Core of the Mentoring in Cardiovascular Biology COBRE centerat LSUHSC-NO. Cells were tested at passages 3-4. Cells were grown inendothelial cell growth medium (Cell Applications, Inc.). Primary ratbronchoaveolar macrophage cells were obtained by lung lavage from ratsand used at day 3 or 4 post plating in DMEM+10% FBS.

All treatments with 5-HT_(2A) receptor agonists occurred 1 hour prior tothe addition of TNF-alpha (10 ng/ml) or LPS (100 ng or 1 mg) dependingon the experiment. All RNA isolations, cDNA synthesis, QPCR geneexpression assays examining ICAM1, VCAM1, and IL6, and data analysiswere performed as described above in Example 1, except the primers weredifferent for the human cell experiment. The human gene PCR primersequences and universal probe numbers were as follows: cyclophillin(control amplicon; Probe U64): forward primer,5′-CCCAGTTCTTCATCACGACA-3′ (SEQ ID NO: 11), reverse primer,5′-GTCTTGGTGCTCTCCACCTT-3′ (SEQ ID NO: 12); and human ICAM-1 (Probe U71,intracellular adhesion molecule 1): forward primer,5′-CCTTCCTCACCGTGTACTGG-3′ (SEQ ID NO: 13), reverse primer,5′-AGCGTAGGGTAAGGTTCTTGC-3′ (SEQ ID NO: 14).

As shown in FIG. 8, 5-HT_(2A) receptor activation with (R)-DOI blockedICAM-1 gene expression in human neuroblastoma cells similar to resultsseen in RASM cells. As shown in FIG. 9, 5-HT_(2A) receptor activationwith (R)-DOI and LA-SS-Az in rat glioma cells blocked ICAM-1 geneexpression similar to results seen in RASM cells.

As shown in FIG. 10, (R)-DOI potently blocked VCAM-1 gene expression inresponse to TNF-α in primary rat bronchoaveolar macrophage cells similarto results seen in RASM cells. The IC50 was about 20 pM.

As shown in FIG. 11A, 5-HT_(2A) receptor stimulation with (R)-DOI (10pM) administered 60 minutes prior to the addition of TNF-alpha (10ng/ml) potently inhibited TNF-α-induced IL-6 expression in rat primaryaortic endothelial cells. However, the effect at inhibiting theTNF-alpha induced increase in VCAM-1 gene expression, was less potent(FIG. 11B).

Thus (R)-DOI was shown to inhibit proinflammatory gene expression inother types of cells, including human cells.

EXAMPLE 10

5-HT_(2A) Receptor Activation on ICAM-1 Gene Expression afterStimulation with Lipopolysaccharide.

The effect of (R)-DOI (60 minute pretreatment) on the expression ofICAM-1 in primary rat aortic smooth muscle cells after stimulation withLPS was examined. As shown in FIG. 12, at a low dose of LPS (100 ng)producing only 2-fold induction of ICAM-1 gene expression, (R)-DOI wasable to block the response. At a higher dose of LPS (1 μg), there was noeffect of (R)-DOI on the increase in ICAM-1. Together, these dataindicate that whereas there may be a moderate effect on low levels ofLPS stimulation, by and large there is little to no effect of 5-HT_(2A)receptor stimulation on inflammation induced by LPS, indicating that theanti-inflammatory effects of 5-HT_(2A) receptor activity are specificfor the TNF-α receptor activated inflammatory mechanisms.

These results indicate that activation of 5-HT_(2A) receptors by(R)-DOI, as well as additional 5-HT_(2A) receptor agonists, representsan extremely potent, therapeutic avenue to explore for the treatment ofdiseases and disorders involving TNF-α-mediated inflammation. TNF-α andTNF-α receptor mediated pathways are believed to be a major component ofmany inflammatory conditions that include atherosclerosis, rheumatoidarthritis, psoriasis, type II diabetes, asthma, Crohn's Disease,inflammatory bowel syndrome, depression, schizophrenia, and Alzheimer'sdisease. Notably, 5-HT_(2A) receptor expression has been detected inmost, if not all, of the tissues mediating the inflammatory conditionsmentioned above. Given the unprecedented and extremely high potency of(R)-DOI to suppress multiple proinflammatory markers rapidly, rangingfrom NOS activity, through NF-κB translocation, to gene expression ofICAM-1, VCAM-1 and IL-6, the predicted therapeutic dose would be atleast two orders of magnitude below that necessary to produceundesirable hallucinogenic side effects. Importantly, because (R)-DOIcan significantly inhibit the effects of TNF-α many hours after theadministration of TNF-α, potential therapies could be aimed at not onlypreventing inflammation, but also treating inflammation or injury thathas already occurred or is ongoing.

Miscellaneous

Following successful completion of animal trials using common mammals,(R)-DOI and other 5-HT_(2A) agonists will be tested in human patientswith symptoms or diseases of enhanced immunological response in clinicaltrials conducted in compliance with applicable laws and regulations.

Specific 5-HT_(2A) agonists used in the present invention may beadministered to a patient by any suitable means, including oral,intravenous, parenteral, subcutaneous, intrapulmonary, and intranasaladministration. Parenteral infusions include intramuscular, intravenous,intraarterial, or intraperitoneal administration. The compounds may alsobe administered transdermally, for example in the form of a slow-releasesubcutaneous implant. They may also be administered by inhalation.Although direct oral administration may cause some loss ofanti-inflammatory activity, the agonists could be packaged in such a wayto protect the active ingredient(s) from digestion by use of entericcoatings, capsules or other methods known in the art.

Pharmaceutically acceptable carrier preparations include sterile,aqueous or non-aqueous solutions, suspensions, and emulsions. Examplesof non-aqueous solvents are propylene glycol, polyethylene glycol,vegetable oils such as olive oil, and injectable organic esters such asethyl oleate. Aqueous carriers include water, alcoholic/aqueoussolutions, emulsions or suspensions, including saline and bufferedmedia. Parenteral vehicles include sodium chloride solution, Ringer'sdextrose, dextrose and sodium chloride, lactated Ringer's, or fixedoils. The active therapeutic ingredient may be mixed with excipientsthat are pharmaceutically acceptable and are compatible with the activeingredient. Suitable excipients include water, saline, dextrose,glycerol and ethanol, or combinations thereof. Intravenous vehiclesinclude fluid and nutrient replenishers, electrolyte replenishers, suchas those based on Ringer's dextrose, and the like. Preservatives andother additives may also be present such as, for example,antimicrobials, anti-oxidants, chelating agents, inert gases, and thelike.

The form may vary depending upon the route of administration. Forexample, compositions for injection may be provided in the form of anampoule, each containing a unit dose amount, or in the form of acontainer containing multiple doses.

A compound in accordance with the present invention may be formulatedinto therapeutic compositions as pharmaceutically acceptable salts, forexample a hydrochloride salt (e.g., the (R)-DOI used in the aboveexamples). These salts include acid addition salts formed with inorganicacids, for example hydrochloric or phosphoric acid, or organic acidssuch as acetic, oxalic, or tartaric acid, and the like. Salts alsoinclude those formed from inorganic bases such as, for example, sodium,potassium, ammonium, calcium or ferric hydroxides, and organic basessuch as isopropylamine, trimethylamine, histidine, procaine and thelike.

A method for controlling the duration of action comprises incorporatingthe active compound into particles of a polymeric substance such as apolyester, peptide, hydrogel, polylactide/glycolide copolymer, orethylenevinylacetate copolymers. Alternatively, an active compound maybe encapsulated in microcapsules prepared, for example, by coacervationtechniques or by interfacial polymerization, for example, by the use ofhydroxymethylcellulose or gelatin-microcapsules orpoly(methylmethacrylate) microcapsules, respectively, or in a colloiddrug delivery system. Colloidal dispersion systems include macromoleculecomplexes, nanocapsules, microspheres, beads, and lipid-based systemsincluding oil-in-water emulsions, micelles, mixed micelles, andliposomes.

As used herein, the term “5-HT_(2A) agonists” is any compound thatincreases the activity of a 5-hydroxytryptamine 2A receptor. Examples ofsuch agonists include DOI (±)-1-(2,5-dimethoxyphenyl)-2-aminopropanehydrochloride; (R)-DOI((R)-1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane) (greater than 95% Renantiomer); LA-SS-Az(2'S,4'S)-(+)-9,10-Didehydro-6-methylergoline-8β-(trans-2,4-dimethylazetidide);2C-BCB (4-Bromo-3,6-dimethoxybenzocyclobuten-1-yl) methylamine; andlysergic acid diethylamide (LSD).

As used herein, an “therapeutically effective amount” of a compound isan amount, that when administered to a patient, human or animal,(whether as a single dose or as a time course of treatment) inhibits orreduces the release of proinflammatory compounds to a clinicallysignificant degree; or alternatively, to a statistically significantdegree as compared to control. “Statistical significance” meanssignificance at the P<0.05 level, or such other measure of statisticalsignificance as would be used by those of skill in the art of biomedicalstatistics in the context of a particular type of treatment orprophylaxis. The term “therapeutically effective amount” thereforeincludes, for example, an amount sufficient to decrease the release ofproinflammatory compounds to a clinically relevant level that isstatistically significant to decrease inflammation. The dosage rangesfor the administration of a compound are those that produce the desiredeffect, but an effective dose that would result in the tissue cellsseeing no greater than a body fluid concentration of no greater than 5nM, more preferable no greater than 1 nM, and most preferably no greaterthan 0.5 nM. For example, a single dose that would result in a 1 nMfinal body fluid concentration in a 60 kg human would be about 20 or for(R)-DOI a single dose that would result in a final body fluidconcentration near the IC50 of about 20 pM would be about 0.4 μg. Thisamount could be adjusted based on the size of the human or animal.Generally, the dosage will vary with the age, weight, condition, and thedegree of the inflammation. A person of ordinary skill in the art, giventhe teachings of the present specification, may readily determinesuitable dosage ranges for the various sizes of different mammals. Thedosage can be adjusted by the individual physician or veterinarian inthe event of any contraindications. In any event, the effectiveness oftreatment can be determined by monitoring the extent of release of knowninflammatory parameters by methods well known to those in the field.

REFERENCES

-   Akiyoshi T, Zhang Q, Inoue F, Aramaki O, Hatano M, Shimazu M,    Kitajima M, Shirasugi N and Niimi M (2006) Induction of indefinite    survival of fully mismatched cardiac allografts and generation of    regulatory cells by sarpogrelate hydrochloride. Transplantation    82:1051-1059.-   Arzt E, Costas M, Finkielman S and Nahmod V E (1991) Serotonin    inhibition of tumor necrosis factor-alpha synthesis by human    monocytes. Life Sci 48:2557-2562.-   Blankenberg S, Barbaux S and Tiret L (2003) Adhesion molecules and    atherosclerosis. Atherosclerosis 170:191-203.-   Ckless K, van der Vliet A and Janssen-Heininger Y (2007)    Oxidative-nitrosative stress and post-translational protein    modifications: implications to lung structure-function relations.    Arginase modulates N F-kappaB activity via a nitric oxide-dependent    mechanism. Am J Respir Cell Mol Biol 36:645-653.-   Cloez-Tayarani I, Petit-Bertron A F, Venters H D and Cavaillon J    M (2003) Differential effect of serotonin on cytokine production in    lipopolysaccharide-stimulated human peripheral blood mononuclear    cells: involvement of 5-hydroxytryptamine2A receptors. Int Immunol    15:233-240.-   Collins T, Read M A, Neish A S, Whitley M Z, Thanos D and Maniatis    T (1995) Transcriptional regulation of endothelial cell adhesion    molecules: N F-kappa B and cytokine-inducible enhancers. Faseb J    9:899-909.-   Crisafulli C, Galuppo M, and Cuzzocrea S (2009) Effects of genetic    and pharmacological inhibition of TNF-alpha in the regulation of    inflammation in macrophases. Pharmacol. Res. Epub 2009 May 18.-   Dunn A J, Swiergiel A H and de Beaurepaire R (2005) Cytokines as    mediators of depression: what can we learn from animal studies?    Neurosci Biobehav Rev 29:891-909.-   Guo Z, Shao L, Du Q, Park K S and Geller D A (2007) Identification    of a classic cytokine-induced enhancer upstream in the human iNOS    promoter. Faseb J 21:535-542.-   Guzik T J, Korbut R and Adamek-Guzik T (2003) Nitric oxide and    superoxide in inflammation and immune regulation. J Physiol    Pharmacol 54:469-487.-   Hansson G K, Robertson A K and Soderberg-Naucler C (2006)    Inflammation and atherosclerosis. Annu Rev Pathol 1:297-329.-   Hughes J M, Arthur C A, Baracho S, Carlin S M, Hawker K M, Johnson P    R and Armour C L (2000) Human eosinophil-airway smooth muscle cell    interactions. Mediators Inflamm 9:93-99.-   Huntjens D R, Danhof M and Della Pasqua O E (2005)    Pharmacokinetic-pharmacodynamic correlations and biomarkers in the    development of COX-2 inhibitors. Rheumatology (Oxford) 44:846-859.-   Ito T, Ikeda U, Shimpo M, Yamamoto K and Shimada K (2000) Serotonin    increases interleukin-6 synthesis in human vascular smooth muscle    cells. Circulation 102:2522-2527.-   Kim Y K, Jung H G, Myint A M, Kim H and Park S H (2007) Imbalance    between pro-inflammatory and anti-inflammatory cytokines in bipolar    disorder. J Affect Disord 104:91-95.-   Kubera M, Maes M, Kenis G, Kim Y K and Lason W (2005) Effects of    serotonin and serotonergic agonists and antagonists on the    production of tumor necrosis factor alpha and interleukin-6.    Psychiatry Res 134:251-258.-   Kurrasch-Orbaugh D M, Watts V J, Barker E L and Nichols D E (2003)    Serotonin 5-hydroxytryptamine 2A receptor-coupled phospholipase C    and phospholipase A2 signaling pathways have different receptor    reserves. J Pharmacol Exp Ther 304:229-237.-   Little K Y, Elmer L W, Zhong H, Scheys J O and Zhang L (2002)    Cocaine induction of dopamine transporter trafficking to the plasma    membrane. Mol Pharmacol 61:436-445.-   Marconi A, Darquenne S, Boulmerka A, Mosnier M and D′Alessio    P (2003) Naftidrofuryl-driven regulation of endothelial ICAM-1    involves nitric oxide. Free Radic Biol Med 34:616-625.-   McLean T H, Parrish J C, Braden M R, Marona-Lewicka D,    Gallardo-Godoy A and Nichols D E (2006)    1-Aminomethylbenzocycloalkanes: conformationally restricted    hallucinogenic phenethylamine analogues as functionally selective    5-HT_(2A) receptor agonists. J Med Chem 49:5794-5803.-   Miller K J and Gonzalez H A (1998) Serotonin 5-HT_(2A) receptor    activation inhibits cytokine-stimulated inducible nitric oxide    synthase in C6 glioma cells. Ann N Y Acad Sci 861:169-173.-   Miller K J, Mariano C L and Cruz W R (1997) Serotonin 5HT_(2A)    receptor activation inhibits inducible nitric oxide synthase    activity in C6 glioma cells. Life Sci 61:1819-1827.-   Nagatomo T, Rashid M, Abul Muntasir H and Komiyama T (2004)    Functions of 5-HT_(2A) receptor and its antagonists in the    cardiovascular system. Pharmacol Ther 104:59-81.-   Nichols D E (2004) Hallucinogens. Pharmacol Ther 101:131-181.-   Nichols D E, Frescas S, Marona-Lewicka D and Kurrasch-Orbaugh D    M (2002) Lysergamides of isomeric 2,4-dimethylazetidines map the    binding orientation of the diethylamide moiety in the potent    hallucinogenic agent N,N-diethyllysergamide (LSD). J Med Chem    45:4344-4349.-   Nichols D E and Nichols C D (2008) Serotonin Receptors. Chem Rev    108:1614-1641.-   Popa C, Netea M G, van Riel P L, van der Meer J W and Stalenhoef A    F (2007) The role of TNF-alpha in chronic inflammatory conditions,    intermediary metabolism, and cardiovascular risk. J Lipid Res    48:751-762.-   Reimold A M (2002) TNFalpha as therapeutic target: new drugs, more    applications. Curr Drug Targets Inflamm Allergy 1:377-392.-   Roebuck K A and Finnegan A (1999) Regulation of intercellular    adhesion molecule-1 (CD54) gene expression. J Leukoc Biol    66:876-888.-   Roth B L and Chuang D M (1987) Multiple mechanisms of serotonergic    signal transduction. Life Sci 41:1051-1064.-   Roth B L, Nakaki T, Chuang D M and Costa E (1986)    5-Hydroxytryptamine2 receptors coupled to phospholipase C in rat    aorta: modulation of phosphoinositide turnover by phorbol ester. J    Pharmacol Exp Ther 238:480-485.-   Saetre P, Emilsson L, Axelsson E, Kreuger J, Lindholm E and Jazin    E (2007) Inflammation-related genes up-regulated in schizophrenia    brains. BMC Psychiatry 7:46.-   Saucier C, Morris S J and Albert P R (1998) Endogenous serotonin-2A    and -2C receptors in Balb/c-3T3 cells revealed in serotonin-free    medium: desensitization and down-regulation by serotonin. Biochem    Pharmacol 56:1347-1357.-   Shulgin A and Shulgin A (1991) PiHKAL. Transform Press, Berkeley.-   Stefulj J, Jernej B, Cicin-Sain L, Rinner I and Schauenstein    K (2000) mRNA expression of serotonin receptors in cells of the    immune tissues of the rat. Brain Behav Immun 14:219-224.-   Tracey D, Klareskog L, Sasso E H, Salfeld J G and Tak P P (2007)    Tumor necrosis factor antagonist mechanisms of action: A    comprehensive review. Pharmacol Ther.-   Tweedie D, Sambamurti K and Greig N H (2007) TNF-alpha inhibition as    a treatment strategy for neurodegenerative disorders: new drug    candidates and targets. Curr Alzheimer Res 4:378-385.-   Urban J D, Clarke W P, von Zastrow M, Nichols D E, Kobilka B,    Weinstein H, Javitch J A, Roth B L, Christopoulos A, Sexton P M,    Miller K J, Spedding M and Mailman R B (2007) Functional selectivity    and classical concepts of quantitative pharmacology. J Pharmacol Exp    Ther 320:1-13.-   Williams R O, Paleolog E and Feldmann M (2007) Cytokine inhibitors    in rheumatoid arthritis and other autoimmune diseases. Curr Opin    Pharmacol 7:412-417.-   Willins D L, Deutch A Y and Roth B L (1997) Serotonin 5-HT_(2A)    receptors are expressed on pyramidal cells and interneurons in the    rat cortex. Synapse 27:79.-   Zerfaoui M, Suzuki Y, Naura A S, Hans C P, Nichols C and Boulares A    H (2008) Nuclear translocation of p65 NF-kappaB is sufficient for    VCAM-1, but not ICAM-1, expression in TNF-stimulated smooth muscle    cells: Differential requirement for PARP-1 expression and    interaction. Cell Signal 20:186-194.

We claim:
 1. A method for the treatment of an inflammatory disorder in amammal, said method comprising administering to a mammal in need of suchtreatment an therapeutically effective amount of a 5-HT_(2A) receptoragonist in an amount no greater than that required to result in a bodyfluid concentration no greater than 5 nM in a pharmaceuticallyacceptable carrier.
 2. The method of claim 1, wherein the 5-HT_(2A)receptor agonist is selected from the group consisting of DOI,(R)-1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane ((R)-DOI),(4-Bromo-3,6 dimethoxybenzocyclobuten-1-yl) methylamine (2C-BCB), and(2'S,4'S)-(+)-9,10-Didehydro-6-methylergoline-8β-(trans-2,4-dimethylazetidide)(LA-SS-Az)3. The method of claim 1, wherein the 5-HT_(2A) receptor agonist is(R)-1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane ((R)-DOI).
 4. Themethod of claim 3, wherein the ((R)-DOI) is administered in an amount inan amount no greater than that required to result in a body fluidconcentration no greater than 1 nM.
 5. The method of claim 3, whereinthe ((R)-DOI) is administered in an amount in an amount no greater thanthat required to result in a body fluid concentration no greater than 50pM.
 6. The method of claim 3, wherein the (((R)-DOI) is administered inan amount in an amount no greater than that required to result in a bodyfluid concentration no greater than 20 pM.
 7. The method of claim 1,wherein the inflammatory disorder is associated with a disease selectedfrom the group consisting of atherosclerosis, asthma, rheumatoidarthritis, psoriasis, type II diabetes, irritable bowel syndrome,Crohn's disease, septicemia, depression, schizophrenia, and Alzheimer'sdisease.
 8. The method of claim 1, additionally comprising administeringone or more compounds selected from the group consisting of DOI,(R)-1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane ((R)-DOI),(4-Bromo-3,6 dimethoxybenzocyclobuten-1-yl) methylamine (2C-BCB),(2'S,4'S)-(+)-9,10-Didehydro-6-methylergoline-8β-(trans-2,4-dimethylazetidide)(LA-SS-Az),lysergic acid diethylamide (LSD), and known anti-inflammatory drugs. 9.A method to reduce the expression of the intracellular adhesion molecule1 (ICAM-1) gene associated with stimulation of the tumor necrosisfactor-alpha receptor in a mammal, said method comprising administeringto a mammal in need of such reduction an therapeutically effectiveamount of a 5-HT_(2A) receptor agonist in an amount no greater than thatrequired to result in a body fluid concentration no greater than 5 nM ina pharmaceutically acceptable carrier.
 10. A pharmaceutical compositionwhich comprises a dose of a 5-HT_(2A) receptor agonist in an amount nogreater than that required to result in a body fluid concentration nogreater than 5 nM in a pharmaceutically acceptable carrier.
 11. Thecomposition of claim 10, wherein the 5-HT_(2A) receptor agonist isselected from the group consisting of DOI,(R)-1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane ((R)-DOI),(4-Bromo-3,6 dimethoxybenzocyclobuten-1-yl) methylamine (2C-BCB), and(2'S,4'S)-(+)-9,10-Didehydro-6-methylergoline-8β-(trans-2,4-dimethylazetidide)(LA-SS-Az)12. The composition of claim 10, wherein the 5-HT_(2A) receptor agonistis (R)-1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane ((R)-DOI).
 13. Thecomposition of claim 12, wherein the ((R)-DOI) is in an amount nogreater than that required to result in a body fluid concentration nogreater than 1 nM.
 14. The composition of claim 12, wherein the((R)-DOI) is in an amount no greater than that required to result in abody fluid concentration no greater than 50 pM.
 15. The composition ofclaim 12, wherein the ((R)-DOI) is in an amount no greater than thatrequired to result in a body fluid concentration no greater than 20 pM.16. The composition of claim 9, additionally comprising administeringone or more compounds selected from the group consisting of DOI,(R)-1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane ((R)-DOI),(4-Bromo-3,6 dimethoxybenzocyclobuten-1-yl) methylamine (2C-BCB),(2'S,4'S)-(+)-9,10-Didehydro-6-methylergoline-8β-(trans-2,4-dimethylazetidide)(LA-SS-Az),lysergic acid diethylamide (LSD), and known anti-inflammatory drugs.